Organization
OPUS COALESCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON DOMANGUE (SOLE MEMBER)
(985) 892-8934
Entity
Organization
Contact information
Practice address
71107 HIGHWAY 21, COVINGTON, LA 70433-7243
(985) 246-5670
Mailing address
127 HIGHWAY 22 E APT NS, MADISONVILLE, LA 70447-9306
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/24/2016
Last updated
05/24/2016
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